Joshua Freeman – Designing a Fair & Equitable Healthcare System

Play

Dr. Joshua Freeman is a family physician, health policy researcher, social justice activist, and writer.  He publishes a widely-read blog, “Medicine and Social Justice”, and in 2015 published a book, Health, Medicine and Justice: Designing a fair and equitable healthcare system (Copernicus Healthcare press), which is available on Amazon and other sites, in both softcover and electronic versions.

This week, Thomas Kim chats with Dr. Freeman about some of the major themes of the book: why the US health care system fails to produce a healthy population, the role of profit in American medicine, why he uses social justice to frame his analyses and commentary, and how the American health care system could become more primary care-centered.

Dr. Freeman is Professor Emeritus at the University of Kansas Medical Center in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016, and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He was a Fulbright Scholar in São Paulo, Brazil in 2003 and served nationally as Treasurer of the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine. He received STFM’s highest honor, the Recognition Award, in 2006. He served as a member of the board of trustees of Roosevelt University in Chicago, as assistant editor of the journal Family Medicine, and also on the board of Southwest Boulevard Family Health Center in Kansas City, KS.

Dr. Freeman is a graduate of the Loyola-Stritch School of Medicine, family medicine residency at Cook County Hospital in Chicago, and faculty development fellowship and Preventive Medicine residency at the University of Arizona.

This interview was lightly edited for clarity.

David Himmelstein – Blending Research & Advocacy

Play

Our guest this week is David Himmelstein. He is a distinguished professor of public health and health policy in the CUNY School of Public Health at Hunter College, adjunct clinical professor at Albert Einstein College of Medicine, and lecturer in medicine at Harvard Medical School. He has served as chief of the division of social and community medicine at Cambridge Hospital.

David has authored or co-authored more than 100 journal articles and three books, including widely cited studies of medical bankruptcy and the high administrative costs of the U.S. health care system. His 1984 study of patient dumping led to the enactment of EMTALA, the law that banned that practice. He is also a co-founder of Physicians for a National Health Program and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. Steffie Woolhandler.

We talk about how he got his start in research by looking at patient dumping practices as a trainee, and how he views advocacy as a natural outgrowth of his research findings. We also talk about his work as a leader in advocacy for a national health insurance program and talk about a few common arguments against such policy changes. Lastly, he gives some advice for folks early in their career who would like to follow his model of research blended with advocacy.

If you like the show, please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

Journal Club – Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists

Play

For this week’s journal club, we are talking about a recent paper from Health Affairs entitled: Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists  by Michael Barnett, Hal F. Yee Jr, Ateev Mehotra, and Paul Giboney. The paper describes and analyzes data from an e-consult system that was rolled out to a network of hundreds of safety-net clinics in Los Angeles County. We are thrilled to have the lead author, Michael Barnett, join us for our discussion! Michael is an Assistant Professor at Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. He publishes prolifically on a variety of topics, and is particularly interested in the primary care-specialty care interface.

Do you use e-consults in your practice? Or do you wish you had access to such a system? Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in future journal clubs or who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening.

Dennis Dimitri – Supervised Injection Facilities

Play

Today we are joined by Dr. Dennis Dimitri, the immediate past-president of the Massachusetts Medical Society (MMS) and current chair of the society’s Task Force on Opioid Prescribing and Physician Communication, to discuss supervised injection facilities, or SIFs. A SIF is a location where individuals may use illegal drugs under the supervision of a medical professional ready to assist in case of an overdose requiring treatment.

Later this month, the MMS will vote on whether to advocate for a task force to assess the feasibility of a pilot SIF in the state of Massachusetts. If the proposal is approved, the MMS will become the first statewide physician organization in the Bay State to advocate for such a pilot program.

We discuss with Dr. Dimitri what it would mean should the MMS advocate for SIFs. We review the evidence on the effect of SIFs on rates of fatal overdoseuptake of Substance Use Disorder treatment, and rates of transmission of HIV and HCV. We talk about the ethical considerations of such a program, whether SIFs enable behaviors harmful to people’s health or they represent harm reduction, and the complex legal considerations involved with a potential pilot program.

Major events of the opioid epidemic in the last few years, such as business owners planning for the possibility of overdose in bathrooms and a recent HIV outbreak stemmed by a needle exchange program in Indiana, raise the potential benefits of SIFs. If you’re interested in reading more, check out recent guest Dr. Sarah Wakeman‘s compassionate and evidence-based case for SIFs in this recent NEJM article. You can also listen to our past episode Dr. Jessie Gaeta on the SPOT program (supportive place for observation and treatment) when she also gave her thoughts on SIFs.

Dr. Dimitri is a family physician and Vice Chair of the Department of Family Medicine at University of Massachusetts and the UMass Memorial Medical Center.

What do you think? In the face of the opioid epidemic, could pilot SIFs in the US also reduce overdose deaths as in Canada and Australia? Tweet us your thoughts at @rospodcast or leave a comment on our facebook page at www.facebook.com/reviewofsystems.  Or, drop us a line directly at contact@rospod.org. We’d love to hear from you – and thanks for listening.

Graphic from of Centers for Disease Control, Opioid Overdose.

Seth Berkowitz – Food Insecurity and Chronic Disease

Play

This week we are joined by Seth Berkowitz to talk about his research examining the associations between food insecurity and health outcomes. Seth is a primary care physician, Instructor of Medicine, and is on faculty in the Division of General Internal Medicine and the Diabetes Research Center at Massachusetts General Hospital.

Seth’s research interests include population management, food insecurity, cost-related medication underuse and the impact of adverse social circumstances on chronic disease management. His goal is to develop and disseminate interventions and care delivery models that address social and economic needs.

Today he joins us to talk about a recent collaboration, funded by an award from the Robert Wood Johnson Foundation Evidence for Action Program, with Community Servings. Community Servings is a Boston-based non-profit organization dedicated to bringing medically tailored meals to chronically ill adults. The study aims to assess whether individuals receiving the medically tailored meals have lower rates of inpatient hospitalization, ED utilization, and medical expenditures.

You can find a piece co-authored by Seth and David Waters, the CEO of Community Servings here, and the Health Affairs article Seth and I talked about examining the effect of eliminating use of SNAP, or food stamps, for sugary sweetened beverages here.

Lastly, if you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

 

David Buck – Caring for High Need, High Cost Patients

Play
This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine.  He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012.
You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here.
Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

Sarah Wakeman: Treating Patients With Substance Use Disorders & the Opioid Crisis

Play

Today we are joined by Sarah Wakeman to talk about substance use disorders, one of the most pressing public health issues of our time. Sarah is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative. She designs systems of care that draw on the strengths of communities to care for patients and residents with addictions. Sarah also practices in the Adult Medicine Department of the MGH Charlestown HealthCare Center.

We talk about the importance of language and discourse on the care for patients with substance use disorders (4:00), how an approach of compassion has proven more effective than the popularized tough love style (7:30) and how rewarding it can be to witness a patient have a Lazarus moment (10:00) in a journey to recovery. We also talk about the very real challenges of caring for this patient population (13:00), the complexities and power dynamics of monitoring (16:15), and what needs to be done to turn around the epidemic (20:45).

You can find the landmark report on the opioid epidemic from our Surgeon General Vivek Murthy here, which is full of helpful information on this topic.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Matt Broaddus: What are Medicaid Block Grants?

Play

This week we are joined by Matt Broaddus to talk about block granting Medicaid, which is a major health policy change that the Trump administration plans to pursue in the coming months. Matt is a Research Analyst in the Health Division at The Center on Budget and Policy Priorities, a non-partisan research and policy institute in Washington DC. His policy, research, and analytical work is conducted in the areas of Medicaid and the State Child Health Insurance Programs.

We start with an overview of the Medicaid program, the largest insurance program in the US. We touch on the possible benefits of block granting (19:00), and how it may affect other industry stakeholders such as health systems, hospitals, community health centers, and insurers that offer Medicaid managed care products (23:20). Lastly we discuss another block granted program, CHIP and why many see it as a successful block grant program (29:00), and one other suggestion that has been made for Medicaid reform, per-capita funding (32:45).

You can find the article we mentioned by Sara Rosenbaum here, as well as some additional resources on block grants from Kaiser Health News and The Commonwealth Fund.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Photo: President Lyndon B Johnson surrounded by supporters and advisors signing Medicare into law.

Jessie Gaeta: SPOT – Supportive Place for Observation and Treatment

Play

Today our guest is Jessie Gaeta, the Chief Medical Officer of Boston Health Care for the Homeless Program. She is a leading advocate for supportive housing for chronically homeless individuals, and has led BHCHPs efforts in responding to the opiate use disorder and overdose crisis, which is what we discussed.

Dr. Gaeta and her colleagues found themselves confronting the reality of opiate overdose as the leading cause of death among Boston’s homeless individuals day after day on their campus. In reaction to this, Gaeta and her colleagues opened SPOT, or Supportive Place for Observation and Treatment – a space within their building where individuals can come after using to ride out a high while being monitored by a nurse for overdose, and for opiate reversal if necessary.

Photo: Jessie Gaeta, MD